A Doctor In Your Phone: Saving Time And Money With Virtual Appointments

Michael McAndrews | Hartford Magazine

Paula Simchock of Burlington, left, used a web-based medical service over her smartphone when her daughter Hannah, 15, suffered from an ear infection over Christmas. Simchock was able to FaceTime with a medical professional from home, and have the problem diagnosed and medicine prescribed.

Paula Simchock of Burlington, left, used a web-based medical service over her smartphone when her daughter Hannah, 15, suffered from an ear infection over Christmas. Simchock was able to FaceTime with a medical professional from home, and have the problem diagnosed and medicine prescribed. (Michael McAndrews | Hartford Magazine)

THERESA SULLIVAN BARGER

This past Christmas Eve, Paula Simchock's 15-year-old daughter Hannah felt miserable from an ear infection. Over-the-counter medicine wasn't touching the pain. Waiting wasn't an option: The family planned to fly the day after Christmas.

"I didn't want her to just have Tylenol and get on a plane with an ear infection," says Simchock, of Burlington. She contacted Doctor On Demand, the telemedicine provider offered through her family's health insurance plan. She waited 20 minutes to "see" a virtual doctor — a bit longer than it had taken her to see a teledoctor in the past.

Sitting in her living room and talking to the doctor through an app on her smartphone, Simchock explained that Hannah had not outgrown her history of ear infections. The doctor asked about Hannah's symptoms and had her hold the phone up to her mouth so she could look down Hannah's throat. The doctor directed Simchock to touch Hannah's glands to see if they were swollen. Once the doctor confirmed the ear infection, she told Simchock that the closest pharmacy was closed and she'd send the prescription to the nearest open pharmacy, in Avon.

The tele-visit with the doctor lasted 20 minutes and cost $49, rather than the $180 it would have cost for a sick visit to Hannah's pediatrician or $120 for a walk-in urgent care center, if either had been open.

"I thought she was very thorough," Simchock says. "It was so convenient."

And she adds, Hannah "didn't even have to change out of her PJs."

For the past few years, Connecticut residents covered by major health insurance companies have been able to access telehealth services around the clock for non-urgent ailments such as flu, cold, sinus problems, urinary tract infection, respiratory infection and pink eye. In the past year or two, providers have added dermatology and behavioral health services. The nation's largest telemedicine provider, Teladoc, offers patients diagnosed with cancer the option of seeking a second opinion from an expert on their particular type of cancer.

Telehealth, which includes telemedicine and telebehavioral health, is growing rapidly and expanding to provide care for a wide list of conditions. In Connecticut, patients with stable, chronic conditions such as hypertension and diabetes are having regular virtual check-ins.

"Right now, our model is responsive and reactive," says Chris Peterson, director of telehealth at Hartford HealthCare. With wearable data, artificial intelligence and other technological advances, he says, patients will increasingly be able to share information and receive medical feedback from their office, home, car or vacation spot. "These changing technologies allow us to become more proactive."

Artificial intelligence will play a bigger role in the triage process, says Dr. Lyle Berkowitz, chief medical officer at MDLIVE. Patients could upload data collected to monitor their health and "a computer system could decide if a patient had to come in or could be handled via a call with a virtualist [virtual doctor] for a quarterly check in," he says. "For, example, a patient with hypertension, heart failure or almost any cardiac disease would measure their blood pressure, pulse and weight regularly. A diabetic would measure their home glucose, while an asthmatic could measure their peak flow meter. They still might come to the office or local pharmacy for lab work, but would not actually have to see the doctor unless they had a new problem."

Doctors, nurse practitioners, psychologists and physical therapists must be licensed to practice in the state where the patient is located. Doctors from Doctor On Demand, Teladoc, Live Health Online and MDLIVE said their virtual doctors also must be board certified and experienced. They reported similar forms of oversight, including patient reviews of every visit. Each time she has seen a virtual doctor, Simchock says she's been sent a questionnaire and asked to rate the doctor.

"We have a vigorous quality team that reviews every chart," says Dr. Mia Finkelston, a family physician who has worked full-time for Teladoc for more than five years. The quality team reviews all prescriptions written for antibiotics, and each virtual doctor receives a monthly score card. If virtual doctors consistently do something that raises a concern, she says, they'll be asked questions by the quality team.

Nationally, there are about 46 million Americans with mental illness, but at least 10 million of them are unable to see a psychiatrist because of shortages and gaps in access, says Dr. Jason Tibbels, vice president of health services with Teladoc, which has been offering telebehavioral health services for more than a year.

Connecticut faces a similar shortage, and Peterson says teletherapy allows behavioral health providers to see more patients and removes barriers that keep some people from seeking mental health treatment. Those whose schedules prohibit them from in-person visits or who avoid treatment because of stigma, he says, "may be more comfortable receiving treatment in their own home."

Teladoc has also added board-certified dermatologists to its staff of virtual doctors, and they treat patients with acne, rosacea and other ongoing skin conditions conducive to virtual medicine, says Tibbels.

Teladoc also offers second opinions for people who have received a cancer diagnosis. After the patient's oncologist collects the clinical information, including pathology and imaging reports, the data is sent to doctors who are considered by their peers to be the best in the world on the particular type of cancer, Tibbels says. The expert reviews the case and creates a summary offering a second opinion, which is sent back to the treating physician.

"There have been hundreds of cases of people who have had diagnostic changes," he says. Sometimes patients had received a false positive or been told their cancer was benign when it wasn't.

Telehealth has expanded to include virtual physical therapy as well. Peterson, a physical therapist, is running a study with Hartford Hospital 's total knee replacement patients. Through an app, patients watch video clips to lead them through their prescribed exercises. They can text their physical therapist with questions. Patients and therapists chat two or three times weekly through video visits.

Hospitals and their care partners have deployed telehealth to help in stroke evaluation, provide support to ICU patients and allow for a timely eConsult to ensure patients are being evaluated by the right specialists, says Karen Buckley, vice president of advocacy at the Connecticut Hospital Association. After surgery, patients can connect with their hospitals virtually to avoid needing to come to the facility or doctor's office.

While virtual doctors can prescribe medications, under Connecticut laws, telehealth providers cannot prescribe most controlled substances, including Adderall, Ritalin and testosterone. CHA is pursuing legislative changes that would allow telehealth practitioners to prescribe the full spectrum of drugs allowed under federal law.

Simchock, a working mom, appreciates the convenience of seeing a doctor through her smartphone, especially on a holiday. During Hannah's 20-minute virtual visit, the doctor even offered tips for minimizing ear pain during take-off and landing.

Michael McAndrews | Hartford Magazine

Paula Simchock and her daughter Hannah, 15. Paula Simchock used a web based medical service over her smart phone to diagnose and prescribe medicine for an ear infection her daughter suffered from on Christmas day. The web based service allowed Simchock to FaceTime with a medical professional while at home and recommend the nearest pharmacy on on the holiday.

Paula Simchock and her daughter Hannah, 15. Paula Simchock used a web based medical service over her smart phone to diagnose and prescribe medicine for an ear infection her daughter suffered from on Christmas day. The web based service allowed Simchock to FaceTime with a medical professional while at home and recommend the nearest pharmacy on on the holiday.

(Michael McAndrews | Hartford Magazine)

ON THE PHONE

Anthem Blue Cross Blue Shield, which contracts with Live Health Online to provide telehealth services in Connecticut, recently surveyed members who have used the service. Some results:

Average time saved: 3.1 hours

Average age of users: 39

Users by gender: 54% female; 46% male

Likely to recommend the service to others (on a 10-point scale where 10 is very likely): 9.75